Surgical access device

ABSTRACT

Surgical device ( 1 ) is for use in minimally invasive surgery using an inflated body cavity ( 2 ) accessible to a surgeon through an access port defined by a sleeve ( 4 ) passing through an incision in a patient&#39;s abdominal wall ( 3 ). The device is held in position by a distal ring ( 5 ) and a proximal ring ( 6 ). The device ( 1 ) is sealed by cuff valve ( 8 ), self sealing valve ( 18 ), spring valve ( 28 ) or snap open/snap shut valve ( 38 ).

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a surgical device for use in minimallyinvasive surgery of the type using patient pneumoperitoneum and anaccess port.

2. Description of Related Art

Minimally invasive surgery of this type is carried out having introducedgas into a patient's body cavity through an incision and sealed theincision with an access port. The access port enables laproscopic andhand or instrument assisted surgery to be performed.

A sleeve forming such a port is shown in WO-A-95/07056 entitled“Apparatus for use in surgery”. The access port sleeve shown is used tocreate a controlled pressurized environment within the sleeve whileallowing a surgeon's arm to pass through the sleeve. During surgery, gasis pumped into the patient's body cavity where the surgery is to beperformed and the sleeve prevents gas escaping while allowing thesurgeon to operate using minimally invasive surgery techniques. Theapplication shows a sleeve having a flange at a distal end provided withadhesive for adhering the device to a patient's body or alternatively amounting ring to surround the incision in a patient's body. Whileproviding a suitable apparatus for performing such surgery the devicedescribed suffers from the principle disadvantage that in use, thesleeve protrudes upwardly from the patient and may interfere with theactivities of the surgery team. Additionally, the sleeve must be sealedagainst the surgeon's upper forearm by clamping the device to the armsufficiently tightly to avoid gas leak around the area of the seal. Thispresents the surgeon with a problem both in sealing the sleeve and insubsequent mobility.

A further problem associated with the use of sleeves of the kinddescribed is that a phenomenon known as “tenting” may occur. “Tenting”means that when the sleeve is adhered to the patient's skin or to asurgical drape and gas is induced into the patient's abdominal cavity,there is a tendency for the sleeve to fill with gas and to pull awayfrom the patient.

U.S. Pat. No. 5,514,133 discloses an endoscopic surgical apparatus forenabling a surgeon to access directly the surgical site during anendoscopic procedure. This apparatus includes an opening extendinglongitudinally through the apparatus and prior art is configured anddimensioned to receive a hand therethrough. A first plate engagesagainst the outer surface of the abdominal wall. A second plate isspaced from the first plate and is movable between a first position anda second position wherein the second plate is in close cooperativealignment with the inner surface of the abdominal wall. An adjustmentmember is mounted to the second plate and actuates movement of thesecond plate between its first position and its second position. A firstsealing member inhibits the flow of gas through said opening and isformed by a pair of overlapping seals. A flexible sleeve extends betweenthe first and second plates and adjusts in length to accommodate variousthicknesses of the abdominal wall. The sleeve also creates an accessport for the passage of objects through the abdominal wall.

SUMMARY OF THE INVENTION

A surgical device for use in minimally invasive surgery of the typeusing an inflated body cavity accessible to a surgeon through an accessport, defined by the device, surrounding an incision in a patient'sbody, the device having: body cavity engagement means for insertion intothe incision to locate the device in position; fixing means forattaching the device to a patients skin, the fixing means including aproximal ring; a sleeve connectable between the body cavity engagementmeans and the fixing means wherein the sleeve is adjustable by thepositioning of the proximal ring so that the positioning of the proximalring retracts the sleeve to define an access port and create a sealbetween the incision and sleeve; and sealing means, at least one ofmounted on the sleeve and operating on the sleeve, to preventsubstantial leakage of gas from the body cavity on inflation when in aninoperative position and formed to mould about a substantial portion ofa surgeon's hand or surgical instrument on insertion in an operatingposition. Preferably, the body cavity engagement means is provided by adistal ring formed for insertion into the incision.

In one arrangement, the distal ring has an associated self-sealingvalve. The fixing means (proximal ring) incorporates adjustment meansfor modifying the length of the sleeve. This ensures that the fixingmeans, distal ring and valves are brought into close contact with theabdominal wall ensuring a good seal is maintained and that the device isfirmly mounted in position.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front view of a surgical device in accordance with theinvention;

FIG. 2 is a section view in the direction of the arrows A—A of thesurgical device of FIG. 1;

FIG. 3 is a view of the self sealing valve forming part of a surgicaldevice in accordance with the invention in an inoperative position;

FIG. 4 is a view of portion of the valve shown in FIG. 3 in an operatingposition;

FIG. 5 is a view of a another alternative self sealing valve formingpart of a surgical device in accordance with the invention in aninoperative position;

FIG. 6 is a view of portion of the valve shown in FIG. 5 in an operatingposition; and

FIG. 7 is a front view of another embodiment of the surgical device ofthe present invention with an external proximal valve instead of aninternal distal valve.

DETAILED DESCRIPTION OF THE INVENTION

Referring to the drawings, and initially to FIGS. 1–2 there isillustrated a surgical device according to the invention, indicatedgenerally by the reference numeral 1. The surgical device 1 is formedfor use in minimally invasive surgery of the type using an inflated bodycavity indicated generally by the reference numeral 2. The cavity 2 isaccessible to a surgeon through an access port, defined by a sleeve 4,passing through an incision in a patient's abdominal wall 3.

In more detail, the device 1 has a body cavity engagement means providedby a distal ring 5 for insertion into the incision to locate the device1 in position. The distal ring 5 prevents the device from becomingdetached from the body inadvertently and has an associated sealing meansin the form of a self-sealing valve 18 for sealing the sleeve 4 when notin use. The device 1 is held in position on the patient's skin outsidethe body by a fixing means 10 provided in this case by a proximal ring6. The distal ring 5 and proximal ring 6 ensure that the device 1 issecurely fixed in position, both rings 5,6 surround the incision and thesleeve 4 passes through the incision connecting the rings 5 and 6. Theproximal ring 6 has adjustment means 12 provided by being rotatablymounted on the skin to modify the length of the sleeve 4. This ensuresthat the fixing means 10 and the distal ring 5 are brought into closecontact with the abdominal wall 3, thereby ensuring a good seal ismaintained and that the device 1 is firmly mounted in position.

The proximal ring 6 may have a connector ring 7 for receiving additionalseals to prevent loss of pressure from the cavity 2. The connector ring7 may also be used for holding or guiding medical instruments intoposition over, through or in the incision.

In use, an incision is made in the abdominal wall 3 and the distal ring5 and associated self-sealing valve 18 is passed through the incisioninto the cavity 2. The self-sealing valve 18 incorporates elasticizedfilaments, which are biased toward a closed position or inoperativeposition (see FIG. 3). The distal ring 5 is moved when in the cavity 2so that the ring 5 surrounds the incision. The proximal ring 6 can thenbe rotated, adjusted in height or stretched to take up the surplusmaterial of sleeve 4 on the proximal ring 6. When the distal ring 5 isdrawn up to snugly engage the internal abdominal wall 3 surrounding theincision, the proximal ring 6 is attached to the patient's skin to fixthe device 1 in position. When in position, the sleeve 4 passing betweenthe portions of the abdominal wall 3 exposed by the incision retractsthe incision sides creating a lumen or bore through which an object orhand can be passed. A seal is provided by the self-sealing valve 18.

When a surgeon wishes to gain access to the cavity 2, a hand orinstrument is passed down through the sleeve 4. The outward pressure ofthe retracted sleeve 4 on the abdominal wall ensures that access is notrestricted. The self-sealing valve 18 is easily operated by the surgeonto gain access to the cavity 2 and surgery can be performed. As anobject is removed, the self-sealing valve 18 closes down sealing thecavity 2. Specifically, when a surgeon passes a hand or instrumentbetween the filaments which run all around the end of the sleeve 4, theyare forced out of position into an operating position as shown in FIG.4. As filaments are used, they accurately mould to the surface of theinserted object preventing loss of gas from the body cavity 2. Thememory resident in these filaments returns the valve 18 to theinoperative position once the object is removed to re-seal the sleeve 4.

It will be noted that equivalent methods of dispensing and retractingslack sleeve material following positioning of the device may be used.

FIGS. 5 and 6 show an alternative to the self-sealing valve 18 describedabove in relation to FIGS. 1–4. In this alternative embodiment, a springvalve 28 provides the seal to the sleeve 4. The spring valve 28 isprovided by mounting a member 27 within a pocket 29 of the sleeve 4.Tension in the spring valve 28 is provided by forming the member 27 tobe longer that the pocket 29. Operation of this valve is identical tothat described above.

It will be understood that the operation of these valves is notdependent on the adjustment means described above.

In a still further arrangement, the proximal ring may be adjusted inheight by means of inserting compressible foam rings between theproximal ring and the abdominal wall. Alternatively, the sleeve may bemade of an elastomer material which when the distal ring is insertedinto the incision, stretches the elastomer sheet causing tension betweenthe distal ring and the proximal ring.

It will be understood that the self-sealing valves 18, 28 describedherein may be equally used as external proximal valves (FIG. 7) or asinternal distal valves.

It will of course be understood that the invention is not limited to thespecific details described herein, which are given by way of exampleonly, and that various modifications and alterations are possible withinthe scope of the invention.

1. A surgical device (1) for use in minimally invasive surgery of thetype using an inflated body cavity (2) accessible to a surgeon throughan access port, defined by the device (1), surrounding an incision in apatient's body, the device (1) having: body cavity engagement means (5)for insertion into the incision to locate the device (1) in position;fixing means (10) for attaching the device to a patient's skin, thefixing means including a proximal ring (6); a sleeve (4) connectedbetween the body cavity engagement means and the fixing means, whereinthe sleeve is adjustable by the positioning of the proximal ring so thatthe positioning of the proximal ring retracts the sleeve to cause thesleeve to apply outward pressure against the patient's body to retractthe incision to define an access port and create a seal between theincision and sleeve; and sealing means, at least one of mounted on thesleeve and operating on the sleeve, to prevent substantial leakage ofgas from the body cavity on inflation when in an inoperative positionand formed to mould about a substantial portion of a surgeon's hand orsurgical instrument on insertion in an operating position.
 2. Thesurgical device of claim 1 in which the body cavity engagement means (5)is provided by a distal ring (5) formed for insertion into the incision.3. The surgical device of claim 2, in which the sealing means includes aself-sealing valve mounted on the sleeve.
 4. The surgical device ofclaim 2, in which the fixing means (6) incorporates adjustment means formodifying the length of the sleeve, so as to ensure that the fixingmeans (6) and the distal ring (5) may be brought into close contact withthe abdominal wall ensuring a good seal is maintained and that thedevice (1) is firmly mounted in position.
 5. The surgical device ofclaim 1, further including a connector ring (7) mounted adjacent saidproximal ring.
 6. The surgical device of claim 1, in which the sleeve ismade of an elastomer material, whereby insertion of the distal ring intoan incision stretches the elastomer material causing tension between thedistal ring and proximal ring.
 7. The surgical device of claim 1,wherein said sealing means is an external proximal valve mountedadjacent to said proximal ring.
 8. The surgical device of claim 1,wherein said sealing means is an internal distal valve.
 9. The surgicaldevice of claim 1, wherein said sealing means is a self-sealing valveformed of elasticized filaments.
 10. The surgical device of claim 1,wherein said sealing means is a self-sealing spring valve including atensioned member mounted on the sleeve.
 11. A surgical device for use inminimally invasive surgery of the type using an inflated cavityaccessible to a surgeon through an access port, defined by the device,surrounding an incision in a patient's body, the device comprising: bodycavity engagement means for insertion into the incision to locate thedevice in position, said body cavity engagement means including a distalring; fixing means for attaching the device to a patient's skin, saidfixing means including a proximal ring; a sleeve connected between thebody cavity engagement means and the fixing means, said sleeve having anadjustable length that shortens to cause said sleeve to apply outwardpressure against the patient's body sufficient to retract the incisionto define the access port; and one of an external proximal sealing valvemounted adjacent to said proximal ring and an internal distal sealingvalve mounted adjacent to said distal ring, to prevent substantialleakage of gas from the body cavity on inflation when in an operativeposition and formed to mold about a substantial portion of a surgeon'shand or surgical instrument on insertion in an operating position. 12.The surgical device of claim 11, wherein said one of an externalproximal sealing valve mounted adjacent to said proximal ring and aninternal distal sealing valve mounted adjacent to said distal ring is aself-sealing valve formed of elasticized filaments.
 13. The surgicaldevice of claim 11, wherein said one of an external proximal sealingvalve mounted adjacent to said proximal ring and an internal distalsealing valve mounted adjacent to said distal ring is a self-sealingspring valve including a tensioned member mounted on the sleeve.
 14. Asurgical device for use in minimally invasive surgery of the type usingan inflated cavity accessible to a surgeon through an access port,defined by the device, surrounding an incision in a patient's body, thedevice comprising: body cavity engagement means for insertion into theincision to locate the device in position, said body cavity engagementmeans including a distal ring; fixing means for attaching the device toa patient's skin, said fixing means including a proximal ring; a sleeveconnected between the body cavity engagement means and the fixing means,said sleeve having a length; wherein said proximal ring includes anadjustment means for adjusting the length of said sleeve to cause saidsleeve to apply outward pressure against the patient's body sufficientto retract sides of the incision; and one of an external proximalsealing valve mounted adjacent to said proximal ring and an internaldistal sealing valve mounted adjacent to said distal ring, to preventsubstantial leakage of gas from the body cavity on inflation when in anoperative position and formed to mold about a substantial portion of asurgeon's hand or surgical instrument on insertion in an operatingposition.
 15. The surgical device of claim 14, wherein said one of anexternal proximal sealing valve mounted adjacent to said proximal ringand an internal distal sealing valve mounted adjacent to said distalring is a self-sealing valve formed of elasticized filaments.
 16. Thesurgical device of claim 14, wherein said one of an external proximalsealing valve mounted adjacent to said proximal ring and an internaldistal sealing valve mounted adjacent to said distal ring is aself-sealing spring valve including a tensioned member mounted on thesleeve.